American Journal of Orthodontics and Dentofacial Orthopedics
Review articleAssessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: A systematic review
Section snippets
Material and methods
To ensure that the search was sensitive to all articles pertaining to our question, we used a truncation of the word “nasopharynx” rather than only “adenoid” to help improve the probability of including any study that focused on the anatomical location in question. We then combined “nasopharynx” with truncated forms of “cephalogram” and “cephalometric” to find articles pertaining to the diagnostic procedure in question. The truncated forms of these terms are listed in Table I. Both the
Results
Our search yielded 11 articles (Table IV) that met the inclusion criteria (Table II).15, 18, 25, 26, 27, 28, 29, 30, 31, 32, 33 The numbers of articles found in each database during our initial search, first phase selection, and final selection meeting the inclusion criteria are given in Table I. Articles that were nearly accepted but in the end rejected are listed in Table V.
Once the articles were selected, we systematically assigned a methodological score to each study to order them in their
Discussion
Because of the relatively high frequency and potential orthodontic consequences of nasopharyngeal obstruction, it is important to have a simple, economical, readily available, and reproducible way to diagnose upper airway obstruction. We performed a systematic review of the literature to determine the capabilities of lateral cephalograms in diagnosing enlarged adenoids and obstructed upper airways. We found 11 studies that met the criteria. In general, the conclusions of these studies depended
Conclusions
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No conclusive evidence was found. All selected studies had some methodological deficiency. Better designed studies with adequate sensitivity-specificity analysis, including receiver-operating characteristic curves should be performed and 3D imaging used as the diagnostic gold standard.
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Cephalograms seem to reliably image the adenoid but are less dependable for diagnosing nasopharyngeal size.
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No consensus for landmarking procedures was found; NcNamara’s line was the only specific measurement with
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